An Overview of Mammary Duct Ectasia

Mammary duct ectasia (periductal ectasia) is a benign (noncancerous) breast condition in which the milk ducts become swollen and clogged. Symptoms can include redness and pain in the nipple and surrounding area, as well as a discharge that can be many colors including black or red. It’s more common in women who are getting close to menopause, though it can happen before then. Thankfully, mammary duct ectasia usually resolves on its own and does not increase the risk of breast cancer.

While the above is true, mammary duct ectasia often causes no symptoms and is found when a biopsy is done for another breast problem.

When symptoms do occur, they can be quite alarming, as some mimic the symptoms of breast cancer:

• A small lump just under the nipple
• Tenderness/irritation of the nipple and areola
• Pink or red color to the nipple and areola
• Thick nipple discharge that is often sticky and dark green or black, though it may also be yellow, white, clear, or even bloody
• Nipple may retraction (pulling inward)

A bacterial infection called mastitis also may develop in the milk duct, causing breast tenderness, inflammation, and fever with or without chills.

Persistent and untreated duct ectasia could lead to the formation of an abscess, a collection of pus in your breast tissue, that may need to be drained.

Duct ectasia results from the normal changes that occur in breast tissues around menopause. The ducts become shorter and wider, and their walls thicken, resulting in the build-up of fluid and increasing their chance of becoming clogged.

Nipple inversion, sometimes due to an underlying breast cancer, can also sometimes cause duct ectasia.

Risk factors for mammary duct ectasia include being menopausal, female, and smoking. That said, mammary duct ectasia has occurred in young children and older adults; it sometimes occurs in men, but this is very uncommon.

Talk to your doctor if you have symptoms of mammary duct ectasia. He or she may be able to diagnose the condition by performing a physical exam, but additional tests may be requested. A breast ultrasound can often show the dilated breast ducts, though a magnetic resonance imaging (MRI) scan is sometimes needed. Mammography sometimes shows calcifications in the region.

When the diagnosis is uncertain, an excisional biopsy is sometimes needed to be sure. A pathologist looks at the sample obtained during the procedure under a microscope to make sure there's no evidence of cancerous cells.

Most of the time, mammary duct ectasia resolves without any treatment. Self-care measures, such as applying warm compresses to your nipple and wearing a supportive bra, can help reduce discomfort. If there's evidence of an infection, antibiotics will be prescribed.

It's important to not squeeze the area to increase discharge, as this can increase inflammation and the chance of an infection developing.

If symptoms don't resolve, surgery may be done to disconnect and remove the duct. Known as Hadfield's operation, the procedure will take about 30 minutes and is usually done under general anesthesia through a tiny incision at the edge of your areola. This removal of a single duct will not affect a woman's ability to breastfeed.

Mammary duct ectasia can be uncomfortable, but fortunately, it's not associated with an increased risk of breast cancer or other complications. Sometimes, surgery will be needed, but most cases resolve on their own in time. It's important to be your own advocate and talk to your doctor about what you may expect and what the next steps might be if your symptoms do not resolve within a particular amount of time. If you're watching your duct ectasia to see if it resolves, it's important to call your doctor with any signs of an infection or an abscess, such as increased pain or a fever.